Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries

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Abstract

Aim. To analyze diagnostic performance of cardiovascular magnetic resonance (CMR) in patients, presented with myocardial infarction with nonobstructed coronary arteries (MINOCA).

Materials ant methods. 46 consecutives patients presented with myocardial infarction without evidence of obstructive coronary disease on angiography between January, 1 2018 and October 1, 2019 were included in the study. All patients underwent CMR within 10 days after admission. MRI was performed on 1.5 T Magnetic Resonance Imaging (MRI) using comprehensive protocol (T2-images, Cine-CMR, late gadolinium enhancement (LGE)).

Results. CMR revealed myocardial infarction (MI) pattern in 14 patients (30.4%), myocarditis in 12 (26.1%), hypertrophic cardiomyopathy in 6 (13.1%). In 14 patients (30.4%) no LGE was observed. Notably in 2 patients without LGE features of takotsubo syndrome were noted. Mean age was significantly lower in patients with MI versus patient with non-ischemic causes of MINOCA (56.1±12.3 vs 64.6±12.8; p=0.04). ST elevation at admission frequency didn’t differ between MI and non-ischemic patients (35.7% vs 25.0%; p=0.76). However MI patients had significantly increased troponin level, 0.87 [0.22; 1.85] vs 0.22 [0.07; 0.38]; p=0.008. CMR allowed to establish the précised clinical diagnosis in 73.9% of the cases.

Conclusion. Clinical data doesn’t allow to differentiate ischemic or non-ischemic causes of MINOCA. However, CMR establish the correct diagnosis in most cases.

About the authors

Ekaterina S. Pershina

Pirogov First City Clinical Hospital

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-3952-6865

к.м.н., рук. центра лучевой диагностики

Russian Federation, Moscow

Dmitry Yu. Shchekochikhin

Pirogov First City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University); Pirogov Russian National Research Medical University

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-8209-2791

к.м.н., врач-кардиолог ГБУЗ «ГКБ №1 им Н.И. Пирогова», доц. каф. профилактической и неотложной кардиологии лечебного фак-та, рук. научно-исследовательского отд. кардиологии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), доц. каф. интервенционной кардиологии и кардиореабилитации ФДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

Georgii M. Shaginyan

Pirogov First City Clinical Hospital

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0001-9289-6104

врач-рентгенолог отд. лучевой диагностики

Russian Federation, Moscow

Alexandra S. Shilova

Pirogov First City Clinical Hospital; Pirogov Russian National Research Medical University

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-4092-5222

к.м.н., зав. 15-м отд-нием реанимации и интенсивной терапии ГБУЗ «ГКБ №1 им Н.И. Пирогова», доц. каф. интервенционной кардиологии и кардиореабилитации ФДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

Andrei V. Sherashov

Pirogov First City Clinical Hospital

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0003-2220-5990

врач-кардиолог 15-го отд-ния реанимации и интенсивной терапии

Russian Federation, Moscow

Maria G. Poltavskaya

Sechenov First Moscow State Medical University (Sechenov University)

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0003-4463-2897

д.м.н., проф. каф. кардиологии, функциональной и ультразвуковой диагностики

Russian Federation, Moscow

Saida Kh. Isaeva

Pirogov First City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: isaevasaida88@mail.ru
ORCID iD: 0000-0001-5861-904X

аспирант каф. кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), врач функциональной диагностики отд. функциональной диагностики ГБУЗ «ГКБ №1 им Н.И. Пирогова»

Russian Federation, Moscow

Mihail Yu. Gilyarov

Pirogov First City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University); Pirogov Russian National Research Medical University

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-2870-3301

д.м.н., проф. каф. кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет). зав. каф. интервенционной кардиологии и кардиореабилитации ФДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова», зам. глав. врача по терапевтической помощи, рук. регионального сосудистого центра ГБУЗ «ГКБ №1 им Н.И. Пирогова»

Russian Federation, Moscow

Alexey V. Svet

Pirogov First City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University)

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-2278-7292

к.м.н., глав. врач ГБУЗ «ГКБ №1 им Н.И. Пирогова», доц. каф. кардиологии, функциональной и ультразвуковой диагностики

Russian Federation, Moscow

Valentin E. Sinitsyn

Lomonosov Moscow State University

Email: isaevasaida88@mail.ru
ORCID iD: 0000-0002-5649-2193

д.м.н., проф., зав. каф. лучевой диагностики и терапии фак-та фундаментальной медицины, зав. отд. лучевой диагностики Медицинского научно-образовательного центра ФГБОУ ВО «МГУ им. М.В. Ломоносова», президент Российского общества рентгенологов и радиологов

Russian Federation, Moscow

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2. Fig. 1. MRI of patients from 4 presented groups: a – c - MI, subendocardial accumulation of contrast agent in the inferior and lateral walls (arrow); d – f - myocarditis, subepicardial accumulation of contrast agent in the lower wall (arrow); g – i - takotsubo syndrome, ballooning of the apex in the film images (left image) and the absence of delayed contrasting of the myocardium (central and right images); k – m - HCM, asymmetric thickening of the interventricular septum (red arrow), focal intramyocardial accumulation of contrast agent in the most hypertrophied basal anterior septal segment of the LV myocardium.

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3. Fig. 2. MRI of a patient with acute myocarditis: a - images in T2 mode with fat suppression, an increase in the MR signal corresponding to edema (arrow) in the lower middle segment of the LV myocardium; b - calculation of the ratio of the intensity of the MR signal from the myocardium to the intensity of the signal from the skeletal muscle (a ratio of more than 2 is a criterion for myocardial edema, Lake Louise); (c) a series of delayed contrast enhancement, intramyocardial accumulation of contrast agent in the lower middle segment of the LV myocardium.

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